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| List of Figures | |
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| List of Tables | |
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| Preface | |
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| Human Performance Problems in Maintenance | |
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| The bad news | |
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| The good news | |
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| Removal versus replacement | |
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| Commission versus omission errors | |
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| Summary | |
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| The Human Risks | |
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| Taking a systems view | |
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| Systems with human elements | |
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| Human-related disturbances | |
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| Each disturbance has a history | |
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| Systems build defences against foreseeable disturbances | |
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| System defences can also fail | |
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| The moral issue | |
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| Errors are like mosquitoes | |
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| Looking ahead | |
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| The Fundamentals of Human Performance | |
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| Psychology meets engineering | |
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| A 'blueprint' of mental functioning | |
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| Limitations of the conscious workspace | |
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| Attention | |
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| The vigilance decrement | |
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| Attention and habit | |
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| Control modes and situations | |
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| Three performance levels | |
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| Stages in acquiring a skill | |
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| Fatigue | |
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| Stressors | |
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| Arousal | |
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| Coping with informational overload | |
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| Personality types | |
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| Biases in thinking and decision making | |
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| Summary | |
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| The Varieties of Error | |
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| What is an error? | |
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| Skill-based recognition failures, slips and lapses | |
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| Rule-based mistakes | |
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| Knowledge-based errors | |
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| Violations | |
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| Violation types | |
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| The consequences of maintenance errors | |
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| Summary | |
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| Local Error-provoking Factors | |
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| Documentation | |
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| Time pressure | |
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| Housekeeping and tool control | |
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| Coordination and communication | |
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| Tools and equipment | |
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| Fatigue | |
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| Knowledge and experience | |
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| Bad procedures | |
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| Procedure usage | |
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| Personal beliefs: a factor promoting violations | |
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| Links between errors and error-provoking conditions | |
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| Summary | |
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| Three System Failures and a Model of Organizational Accidents | |
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| Latent conditions and active failures | |
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| The Embraer 120 crash: a shift turnover failure | |
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| The Clapham Junction rail collision: the defences that faded away | |
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| The Piper Alpha explosion: Failures of both the permit-to-work and the shift handover systems | |
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| Modelling organizational accidents | |
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| Defences | |
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| Summary | |
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| Principles of Error Management | |
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| Nothing new | |
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| The principles of error management | |
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| The management of error management | |
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| Summarizing the EM principles | |
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| Person and Team Measures | |
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| Person measures | |
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| Team measures | |
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| Summary | |
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| Workplace and Task Measures | |
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| Fatigue management | |
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| Task frequency | |
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| Design | |
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| Housekeeping | |
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| Spares, tools and equipment | |
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| Using procedures to manage omissions | |
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| Summary | |
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| Organizational Measures | |
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| How accidents happen: a reminder | |
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| Reactive and proactive measures: working together | |
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| Reactive outcome measures | |
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| Proactive process measures | |
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| Identifying gaps in the defences | |
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| Summary | |
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| Safety Culture | |
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| What is a safety culture? | |
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| Can a safer culture be engineered? | |
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| Creating a just culture | |
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| Creating a reporting culture | |
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| Creating a learning culture | |
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| Types of safety culture: the good, the bad and the average | |
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| Summary | |
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| Making it Happen: The Management of Error Management | |
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| Here comes another one | |
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| The common features of safety and quality management systems | |
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| Why error management is necessary | |
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| More on mindset | |
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| In search of resilience | |
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| Summary | |
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| Index | |